IVY CREEK OF TALLAPOOSA (NPI# 1194278614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194278614 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF TALLAPOOSA |
| Other Organization Name | LAKE MARTIN FAMILY MEDICINE, RHC |
| Practice Address |
301 Mariarden Rd Dadeville AL 36853-6254 |
| Practice Telephone | 2568257871 |
| Mailing Telephone | 2568257871 |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2016-08-02 |
| Authorized Official Name | BONNIE MCCLENDON (OFFICE MANAGER) |
| Authorized Official Telephone | 2568253208 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
1-125160 | AL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 363LF0000X | 05 |
| Other Name | Type Code |
|---|---|
| Lake Martin Family Medicine, RHC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811169857 | Ivy Creek of Tallapoosa | Emergency Medical Technician, Basic | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2008-03-31 |
| 1720273303 | Ivy Creek of Tallapoosa | General Acute Care Hospital | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2007-09-07 |
| Street Address |
301 MARIARDEN RD |
| City | DADEVILLE |
| State | AL |
| Zip Code | 36853-6254 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114929742 | Kimberly A Robertson | Nurse Practitioner | 301 Mariarden Rd, Suite D, Dadeville, AL 36853-6254 | 2005-08-12 |
| 1508314865 | Cathy Pitts | Nurse Practitioner | 301 Mariarden Rd, Suite D, Dadeville, AL 36853-6254 | 2016-09-15 |
| 1912359100 | Brian Heath Daniel | Nurse Practitioner | 301 Mariarden Rd, Suite D, Dadeville, AL 36853-6254 | 2016-07-12 |
| 1780036426 | April Dye I | Nurse Practitioner | 301 Mariarden Rd, Suite B, Dadeville, AL 36853-6254 | 2016-07-06 |
| 1952634248 | Laura R Daniel | Nurse Practitioner | 301 Mariarden Rd, Dadeville, AL 36853-6254 | 2009-09-17 |
| 1225211709 | Ivy Creek of Tallapoosa LLC | Home Health | 301 Mariarden Rd, Suite F, Dadeville, AL 36853-6254 | 2007-12-07 |
| 1952407215 | Lake Martin Pharmacy | Pharmacy | 301 Mariarden Rd, Suite A, Dadeville, AL 36853-6254 | 2006-09-15 |
| 1164538203 | Robert William Bartel | General Practice | 301 Mariarden Rd, Dadeville, AL 36853-0129 | 2006-08-22 |
| 1598797656 | Barbara Wilder | Nurse Practitioner | 301 Mariarden Rd, Dadeville, AL 36853-6254 | 2006-07-07 |
| 1790717858 | John Raymond Durant | General Practice | 301 Mariarden Rd, Ste D, Dadeville, AL 36853-0129 | 2006-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528378197 | Ivy Creek Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 201 Mariarden Road, Dadeville, AL 36853 | 2010-10-18 |
| 1912125535 | Casey Turner | Pharmacist | 459 North Broadnax Street, Dadeville, AL 36853 | 2007-04-20 |
| 1053467100 | Anthony Leon Nix | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-01-25 |
| 1407879083 | Karen J Mockler | Family Medicine | 1034 South Tallassee Street, Dadeville, AL 36853 | 2006-07-25 |
| 1902947336 | Frank Langley Pearson | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-02-09 |
| 1194871251 | Pamela Bass Gam | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-01-25 |
| 1124298351 | State of Alabama | Public Health or Welfare | 535 N Broadnax St, Dadeville, AL 36853-0100 | 2008-03-04 |
| 1740487610 | Tallapoosa County | Local Education Agency (LEA) | 125 N Broadnax St, Dadeville, AL 36853-1318 | 2007-07-02 |
| 1659301174 | Frances Kahanec Bartel | Family Medicine | 139 E Lafayette St, Dadeville, AL 36853-1322 | 2006-07-03 |
| 1790803690 | Robert Wm Bartel Mdpc | Family Medicine | 139 E Lafayette St, Dadeville, AL 36853-1322 | 2007-03-27 |
| Find all providers in zip 36853 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932130002 | Ivy Creek of Tallapoosa LLC | Clinic/Center | 301 Mariarden Rd, Dadeville, AL 36853-0129 | 2006-07-06 |
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|---|---|---|---|---|
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| 1952952541 | Pediatric Associates of Alexander City PC | Clinic/Center | 21 Coosa County Road 50, Kellyton, AL 35089-1900 | 2019-09-25 |
| 1205309044 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 184 William E Hill Drive Ste C, Carrollton, AL 35447 | 2019-01-04 |
| 1487123915 | Physicians Care of Camden LLC | Clinic/Center | 24b Camden Byp, Camden, AL 36726-1770 | 2018-11-14 |
| 1336634666 | Central Pediatrics of Somerville LLC | Clinic/Center | 3609 Highway 67 S, Somerville, AL 35670 | 2018-06-28 |
| 1578060349 | Ivy Creek of Elmore, LLC | Clinic/Center | 4412 Hogan Rd, Deatsville, AL 36022-3400 | 2018-04-09 |
| 1568915106 | Physicians Care of Grove Hill LLC | Clinic/Center | 127 Clark St Ste C&d, Grove Hill, AL 36451-3050 | 2016-08-01 |
| 1205294428 | Red Bay Hospital Outpatient Clinics LLC | Clinic/Center | 14490 County Line Road, Suite A, Muscle Shoals, AL 35661 | 2016-02-02 |
| 1972985968 | Athens Limestone Pediatric Center LLC | Clinic/Center | 101 Fitness Way Ste 2100, Athens, AL 35611-2494 | 2015-06-25 |
| 1396125258 | D W Mcmillan Memorial Hospital | Clinic/Center | 1674 Cleveland Ave, Castleberry, AL 36432 | 2015-06-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.